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International Cooperation in Brazil: Children’s HeartLink

Ulisses Alexandre CrotiI; Domingo M BraileI

DOI: 10.1590/S0102-76382010000100004

Children's HeartLink (CHL)(CHL) is a nongovernmental, nonprofit organization, founded in 1969 by Dr. Joseph Kiser, headquartered in Minneapolis, Minnesota, USA (

One of the main goals of the organization is to collaborate in the development, training and mobilizing people and institutions to help children with heart defects around the world.

It works in partnership with hospitals recognized as a benchmark in pediatric cardiovascular surgery in developed countries to offer continuing education and training, primarily for professionals involved in clinical and surgical treatment of children with heart disease in countries like Ecuador, India, Malaysia, Ukraine, Vietnam, South Africa, China and now Brazil.

Some time ago, Full Professor Rodolfo A. Neirotti, in conversation with Full Professor Domingo Braile in international congresses, demonstrated the possibility of including Brazil among the countries to be beneficiaries of a partnership with the CHL.

During the 35th Congress of the Brazilian Society of Cardiovascular Surgery, held in São Paulo between 18 and 20 April 2008, at request of the CHL, the pediatric cardiovascular surgeon Full Professor Rodolfo A. Neirotti came to Brazil with the task of identifying some centers of pediatric cardiovascular surgery that could be visited and evaluated for a future partnership.

Full Professor Neirotti is a cardiovascular surgeon with extensive experience in pediatric cardiovascular surgery, Master in Public Administration at Harvard University and volunteer for CHL. Part of his training was performed in Brazil in the early 60's, with Full Professor E. J. Zerbini. Therefore, he knew the country well, in addition to maintain contact with many colleagues of the Brazilian Society of Cardiovascular Surgery, who at the time could informally indicate him Services of Cardiovascular Surgery in some cities in Brazil.

In December 2008, a group representing the CHL, which currently receives financial support from various sources, including the Medtronic Foundation, was in Brazil visiting the predetermined places.

São José do Rio Preto was chosen for having the best conditions of development, since the city is a wide-range pioneer in cardiovascular surgery in Brazil.

Participated in this visit the director of international programs at the time, John Cushing, the coordinator Andreas Tsakitos, the pediatric cardiologist at Stanford University School of Medicine, Dr. Paul T. Pitlick, and Full Professor Neirotti.

The visit to the Pediatric Cardiovascular Surgery Service of São José do Rio Preto, Hospital de Base - São José do Rio Preto Medical School (HB - FAMERP) lasted two days. The visiting group explained about the projects of the CHL and its goals, and noted a statement on who we were, what we did and how we worked.

It was clear that the partnership program between the CHL and one center in Brazil would depend on several factors and would have several stages.

The main factors would be the identification of a site with potential for the development of pediatric cardiology and cardiovascular surgery, including the minimum number of 100 surgeries a year, interest from the medical team and the board of directors the Hospital in local improvement, participation in information and responsibilities with mutual collaboration.

In the case of a possible relationship, there would be five stages:

1. Recognition of a site with potential;

2. Local evaluation performed by a volunteer physician;

3. Pilot program with a group to assess the site chosen;

4. Active local participation with education and training, technical assistance, financial support for treatment of some patients, critical supplies and equipments;

5. Continued collaboration after a suitable and consistent level of care.

Our team, guided since the beginning by Full Professor Domingo Braile, presented itself as a structured Pediatric Cardiology and Cardiovascular Surgery Service, consisting of surgeons, pediatric cardiologists, anesthesiologists, perfusionists, physiotherapists, nurses and other professionals involved in patient care.

We were able to demonstrate the scientific and academic participation, the growing number of surgeries, and care to children from all over Brazil, with support from an Association of Friends of Children with Cancer and Heart Disease) ( and a company of supply of the material used in the treatment of children in our country, Braile Biomédica S/A.

With evidence of the Children's Hospital, in the final stages of construction, we presented this as an opportunity, unique and of great impact for future expansion in volume and quality of care to be provided to children with heart disease.

On May 19, 2009, we received an email from Ms. Estelle Brouwer, vice-president and director of international programs, stating that our center was selected by the CHL for cooperation in Brazil.

The conversations have began and, in July 2009, we received the second visit of Full Professor Neirotti, as representative of CHL. During a week he observed the behaviors, operations and all the routine of our work, attempting to make a deeper diagnosis of the positives and negatives points. This analysis was also intended to prepare the coming of the first complete mission of volunteer professionals to our country.

We submit the application for the release of medical activities and other foreign professionals to the Regional Council of Medicine (CRM) in order to legalize the mission.

HB-FAMERP fully supported the project, preparing rooms for meetings, mobile phones to facilitate communication between the teams, transportation, meals and hiring of translators day and night in all units, a fact that was of great importance to integration and allowed information exchange at all levels of care.

In September 2009, the first visit of a group of professionals from Mayo Clinic took place. This group was led by Dr. Joseph A. Dearani, a prominent cardiovascular surgeon and medical director of CHL.

The team of 10 professionals led by Dr. Dearani consisted of the pediatric cardiologist, Dr. Shanthi Sivanandam, the anesthesiologist, Dr. Roxann Barnes, the perfusionist, Dave Clements, nurses, Anita Wattier, Lisa Belch, Deanna Gage and Jill Misgen, the physiotherapist, Ed Schneider, the surgical technician, Joan Wobig, and Full Professor Neirotti.

The main objectives were to familiarize the team with our routines, research, service demands and priorities, seeking a lasting professional relationship, participating in the diagnosis and treatment of patients, and offering observations and recommendations aiming at planning the technological advancement in Hospital.

For a week our team could see and be seen working by the team of Dr. Dearani. What we have seen in this amazing experience was a group of volunteer professionals, with high capacity, very interested in discussing the clinical and surgical cases, demonstrating their behaviors and how we could improve the procedures of our routine.

The unquestionable ethical position of the team of Dr. Dearani was absolutely spectacular, drawing our attention to the enormous respect for people who work here and our behaviors.

Immediately we noticed a huge improvement in selfesteem and the greatest interest of all of our team in improving the quality of care to children with heart disease.

At the moment, with the help of the CHL, we are initiating participation in a study group, Quality Improvement Collaborative for Congenital Heart Surgery, led by Dr. Kathy Jenkins, from Boston Children's Hospital. The aim is to identify risk factors for morbidity and mortality, introduce international standards and compare our outcomes with those of other centers around the world.

We also began preparations to receive a new team in June, with attention focused on the overall treatment in the neonatal period.

Finally, we believe that this experience of partnership with the CHL will result in higher training of professionals of our team, working as a multiplicative factor for improvement in caring for children with congenital heart diseases in Brazil.
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